Provider Demographics
NPI:1215169727
Name:SEKULA-SMITH, STEPHANIE A (PA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SEKULA-SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2027
Mailing Address - Fax:305-500-2155
Practice Address - Street 1:260 US HIGHWAY 181 N
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3136
Practice Address - Country:US
Practice Address - Phone:830-393-8222
Practice Address - Fax:855-278-4529
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06089363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320258202Medicaid
TXPA06089OtherLICENSE
TX385095ZLM2Medicare PIN